The vast majority of nursing directors are women but more work is needed to ensure gender balance in other key leadership roles, according to a new report.
The report, which is the first in-depth analysis of female representation on NHS boards, found more than 85% of chief nurses at NHS trusts and arms-length bodies were women.
”We need a greater understanding of why these women [in NHS trusts] are not making it up to these major roles [in arms length bodies] in equal numbers as men”
Women on NHS Boards report
The percentage of female chief executives, who include several former nurses, was 42.6%.
However, the report found women were under-represented when it came to other key roles. Just over 26% of finance directors and only about a quarter of medical directors were women.
The report, called Women on NHS Boards: 50:50 by 2020, was written by Professor Ruth Sealy of the University of Exeter and published in conjunction with NHS Employers and NHS Improvement.
It looks at data from 452 organisations in total, including trusts, arms-length bodies and a sample of clinical commissioning groups.
The proportion of women serving on boards at these organisations ranged from 8.3% to 80%.
However, the overall average was 41% with women currently holding 2,529 of the 6,118 board seats researchers had data on.
“Women have been in the NHS long enough to occupy the top roles, and I am encouraged by the progress in this area. It is certainly not a problem of supply”
Professor Ruth Sealy
In order to achieve a target of 50:50 representation by 2020, NHS boards in England would need to see an extra 500 women taking up leadership roles, said the report.
Across trusts overall, executive roles were more or less balanced between men and women. However, there was “a real imbalance in certain roles”, the report found.
While the percentage of female chief nurses was very high and “reflects the nursing population”, figures for chief finance officer and medical directors were “disappointingly low”, says the report.
Non-executive directorships were also unbalanced with approximately one third women and two thirds men.
The researchers found no significant regional differences in the number of women on trust boards. However, there were differences between types of trusts with the proportion of female directors ranging from exactly 50% at community trusts to 35.7% at ambulance trusts.
The proportion of female directors was 46.2 % for community and mental health trusts, 45.9% at mental health trusts, 42.3 % at specialist trusts and 41% at acute trusts.
Danny Mortimer cut out masthead
The report also examined the age of executives and length of tenure.
When it came to the age of executives at trusts – women outnumber men in the 45 to 50 and 50 to 55 age groups but this drops off significantly after 55.
“This spike is possibly due to the majority of chief nurses retiring at this age,” said the report.
The team looked at the make-up of boards at seven arms length bodies - NHS Improvement, NHS England, the Care Quality Commission, Public Health England, Health Education England, the National Institute for Health and Care Excellence, and the Department of Health.
Just 38.% – or 36 of the 94 directors - were women.
“On the major ALB boards, women and men are roughly split one third/two thirds for both executive director and non-executive director roles,” said the report.
“Given the more balanced proportion of women holding executive director roles across the trusts, we need a greater understanding of why these women are not making it up to these major roles in equal numbers as men,” it added.
At CCGs, key roles often include the chief nurse. However, the report only focused on a selection of leadership posts - chair, chief executive or accountable officer, finance director, and vice or deputy chair.
While almost 40% of chief executives or accountable officers were female, the figures for chair and vice-chair were very low at around 15%.
Professor Sealy stressed the fact woman make up 77% of the NHS workforce but noted there was still work to be done to ensure gender balance at the top.
“Women have been in the NHS long enough to occupy the top roles, and I am encouraged by the progress in this area. It is certainly not a problem of supply,” she said.
“But the fact that women are still underrepresented in key decision-making jobs, such as medical and finance directors, shows there is still work to be done.
”While this report makes strides in highlighting the differences of women on NHS boards, more research is needed to understand their diversity beyond gender”
“The will is there to make sure women are really playing an equal role running the NHS. But now may be the time for people to start getting impatient if they are to meet the target of gender-balanced boards by the 2020 deadline,” she added.
Danny Mortimer, chief executive of NHS Employers, said a diverse workforce improved the quality of decision-making, adding: “The number of female directors of nursing more accurately reflects the gender composition of the workforce and we must replicate this across the whole system.”
The Royal College of Nursing’s equalities officer, Wendy Irwin, said today’s report showed there was still “a huge task ahead to achieve gender equality in the NHS”.
“While this report makes strides in highlighting the differences of women on NHS boards, more research is needed to understand their diversity beyond gender and where discrimination is experienced by staff. It is vital employers make workplaces inclusive so we can make the most of the talent available,” she said.